In 2010, the National Heart, Lung, and Blood Institute of the National Institutes of Health established a Center for Cardiovascular Outcomes Research at Yale University, one of three identified after a national competition. CCOR’s 4-year grant provided the research infrastructure to develop a national surveillance program for cardiovascular care and outcomes. This allowed the opportunity to look at current care patterns and treatment outcomes, identify best practices, evaluate cost-effectiveness, and develop and refine tools for measuring outcomes. CCOR also supported scholarship with practical value to clinical practice and health care policy.
CCOR Project 1 – ENCORE Examining Novel Cardiovascular Outcomes and Regional Effects
We sought to better understand the patterns and systems of care that lead to improved patient outcomes through two allied projects. In the first project, which was built upon our existing Medicare database, we will pursue scholarship that characterizes top performance and its key determinants. We harvested this data structure through collaborative research. ENCORE’s aims were as follows:
- To characterize hospital and regional (hospital referral region (HRR)) performance and patient-level outcomes, assess patient, organizational and regional time trends, and determine factors associated with performance and improvement, defined by the CMS publicly reported measures (AMI, HF, PCI and ICD), as well as other cardiovascular conditions, tests and procedures, cardiovascular risk factors and control conditions.
- To investigate hospital and regional performance and patient-level outcomes using novel measures that focus on a longer episode of care (1-year mortality measures for patients hospitalized with cardiovascular conditions, tests and procedures, cardiovascular risk factors and control conditions) and population-based hospitalization rates (HRR hospitalization rates for cardiovascular conditions and procedures, cardiovascular risk factors and control conditions).
- To characterize the costs of care for cardiovascular conditions and procedures, cardiovascular risk factors and control conditions, during the index hospitalization, in the first 30 days and 1 year after admission, and investigate how costs and payments relate to patient outcomes and hospital and regional performance (30-day and 1-year risk-standardized mortality and 30-day readmission).